Cardiac Cowboys – Episode 4: The Transplant Race

Host: Chris Pine
Date: September 29, 2025
Presented by: iHeartPodcasts
Writer/Producer: Jamie Napoli

Episode Overview

This episode, titled "The Transplant Race," chronicles the dramatic and emotional race to achieve the world’s first successful human heart transplant during the 1960s. It explores the obsessive ambitions, rivalries, and innovations of surgeons in the U.S. Midwest, Texas, and ultimately South Africa, highlighting the personal and professional stakes for those involved. The story centers on Christian Barnard’s historic first transplant in Cape Town, the global response, and the subsequent challenges that heart transplantation faced in its infancy.

Key Discussion Points and Insights

1. The “Moonshot” of Heart Surgery (00:35–03:05)

• Chris Pine opens by drawing parallels between the 1960s heart transplant drive and the era’s broader spirit of daring exploration, likening it to the moonshot.

• Quote:
  “We choose to go to the moon in this decade and do the other things... because they are hard.” (01:28 – Various voices echoing Kennedy's famous words)

• Dr. Norman Shumway of Stanford University emerges as the leading American contender, announcing he is ready for a human heart transplant—if he can secure the right donor and recipient.

• This public declaration “lit a fire” under other surgeons worldwide.

2. The American Heart Disease Crisis and the Call for Transplantation (03:05–05:05)

• By the 1950s, heart disease had become an American epidemic, partially due to sedentary lifestyles, smoking, and dietary habits.
• Surgeons like Walt Lillehei and Earl Bakken had already pushed technical boundaries with devices like the pacemaker.
• Transplantation was seen as the next logical—and life-saving—step.

3. The Global Field of Contenders (05:05–06:42)

• Not just Shumway, but also Dr. Adrian Cantrowitz in Brooklyn and Dr. James Hardy in Mississippi—who infamously attempted a transplant with a chimpanzee heart—were racing to be first.
• Major advances in cardiac surgery were coming not from elite East Coast institutions but from ambitious outsiders and under-resourced teams.
• The world’s fascination with the heart was as much emotional as medical.

4. The Shock of Barnard’s Win (06:42–07:55)

• Christian Barnard, a relatively unknown South African surgeon, beats the American frontrunners to conduct the first successful human heart transplant on December 3, 1967.
• Quote:
  “Some joker down in Africa has done a heart transplant.” (06:30 – A surgeon’s shocked reaction)
• Overnight, Barnard becomes a global celebrity.

5. Barnard’s Unlikely Path (07:55–11:26)

• Barnard’s childhood in poverty, his family’s anti-apartheid stance, and the loss of a brother to congenital heart disease shaped his ethos.

• Cindy Ladigan (Heart of Cape Town Museum):
  “When he brought intensive care to South Africa... He had this attitude of if you didn’t like it, you could go die at home.” (09:26)

• Fierce maternal expectations and trauma from family tragedy drove Barnard's relentless striving.

• He scraped together scholarships for medical school and became known for his grit and charisma.

6. Barnard’s Training and Crucible in America (11:26–15:10)

• Recruited to study in Minnesota with famed surgeons like Walt Lillehei and Owen Wangenstein, Barnard excelled in research and learned pioneering cardiac techniques.

• Adam Barnard (nephew):
  “He could make you feel a million dollars in two seconds. But he could also make you feel the biggest fool in two seconds.” (13:34)

• Barnard’s surgical confidence was shaken after he made a fatal mistake on a young patient, but Lillehei’s mentorship shaped his resilience.

• Dr. Craig Lillehei:
  “Good judgment comes from experience and experience comes from bad judgment.” (17:03)

7. Shumway Versus Barnard: Contrasts and Rivalries (15:10–20:03)

• Norman Shumway’s quiet, self-deprecating style contrasted with Barnard’s flair.
• Dr. Sarah Shumway (Norm’s daughter):
  “He told me... to keep things light so people didn't get too overwhelmed by the fact they were cutting out people's hearts.” (18:53)
• Both men returned to their home institutions, each determined to be first.

8. Overcoming Technical and Ethical Obstacles (20:25–26:34)

• Back in Cape Town with new equipment, Barnard faced his own “ticking clock” due to rheumatoid arthritis.
• Shumway struggled with the lack of viable donors—surgeons still needed to redefine “death” around brain activity and not heartbeat.
• Norm Shumway:
  “Even our neurosurgeons were very slow to come to grips with brain death.... This was a difficult problem.” (24:17)
• Immunosuppression (preventing rejection) was another enormous challenge.
• Barnard’s visit to the U.S. enabled him to adopt American techniques for transplantation, further stoking controversy.

9. The Night It Happened: Barnard’s Operation (27:58–36:32)

• The tragic accident that killed Denise Darvall provided the right donor at the right time for Louis Washkansky, a critically ill patient.
• Edward Darvall’s decision:
  “If you cannot save the life of my daughter, then you need to save the life of that man.” (33:11)
• The technical details and emotional high stakes of the transplant procedure are vividly described.
• Christian Barnard (archive):
  “When I left the hospital that morning... not one photographer, not one television camera... I said... we better tell someone in the hospital that we’ve done a heart transplant tonight.” (36:42)

10. Aftermath and Ripple Effects (36:56–45:53)

• News spreads worldwide; Barnard becomes a celebrity, but resentment and rivalry simmer.
• Denton Cooley (telegram):
  “Congratulations on your first heart transplant, Chris. I will soon be doing my 100th.” (37:48)
• Norm Shumway’s daughter:
  “Dad seemed to be quite excited that a transplant had been performed... I think that wasn't the prize he was after.” (38:43)
• Barnard’s operation legitimized brain death as a criterion for organ donation.
• Heart transplants sweep the globe, but early results are sobering—most recipients die within months.
• Barnard endures both adulation and vilification.

11. The Surgeons Become Astronauts of Medicine (41:41–45:53)

• Denton Cooley:
  “You feel like you're something like an astronaut, you know ... In those early events, we were, I think, glorified beyond reason.” (41:41)

• Despite initial successes, a backlash forms as early transplants mostly fail; heart swapping is equated to “direct killing.”

• Cindy Ladigan:
  “People that were asking for his earlier race because he should be had up for murder. People that said he was unmoral and a bunch of ghouls.” (45:38)

• The “fever breaks” and transplant surgery faces an existential threat.

Notable Quotes and Memorable Moments

• On the spirit of 1960s innovation:
  “We choose to go to the moon in this decade and do the other things... because that challenge is one that we’re willing to accept.” (01:32 – various voices)

• On the motivations behind heart transplantation:
  “The American dream was killing us. For patients whose hearts were damaged beyond repair, a transplant was the only hope for survival.” (04:01 – Chris Pine)

• On losing the transplant dash:
  “Some joker down in Africa has done a heart transplant.” (06:30 – American surgeon, recounting the surprise)

• On the emotional cost of failure:
  “He lay on the couch there and... was crying because he was a very likable man, Mr. Wishkansky... It was great sorrow that we let him down.” (39:46 – Dr. Christian Barnard)

• On fame as a double-edged sword:
  “Fame is quite a lethal drug. My father used to say that the worst drug in the world is somebody claps hands at you because it goes to your head, you know. That did unfortunately get to my uncle.” (43:27 – Adam Barnard)

Timestamps to Key Segments

• 00:35 — Introduction: The "moonshot" of heart surgery; Norm Shumway’s announcement
• 03:05 — The American heart disease crisis and need for cardiac innovation
• 05:05 — The list of global contenders in the “transplant race”
• 06:42 — Christian Barnard conducts the first human heart transplant
• 07:55 — Christian Barnard’s early life and motivations
• 11:26 — Barnard’s Minnesota training and traumatic OR experience
• 15:10 — Contrasting approaches of Barnard and Shumway; rivalry
• 20:25 — Barnard's return to Cape Town with new skills and urgency
• 23:19 — Shumway’s technical and ethical obstacles
• 27:58 — The events leading up to, and the night of, the transplant
• 36:32 — Aftermath: The media storm and global reaction
• 41:41 — “Medical astronauts” and the rise (and fall) of transplant fever
• 45:14 — Backlash, failures, and heart transplants "on trial"
• 46:27 — Teaser for next episode: mechanical hearts and feuding Texas legend

Conclusion

"The Transplant Race" delivers a dramatic, highly personal account of how ambition, circumstance, and sheer will brought about the first heart transplant, while also capturing the cost—ethical, emotional, and scientific—of such groundbreaking work. The episode deftly illustrates that behind every celebrated “first” in medicine are dozens of unsung heroes, fateful coincidences, bitter rivalries, and moments of deep human vulnerability.

Next Episode Tease: The rise of the artificial heart—and the feud between DeBakey and Cooley.